MEDICARE: DR. PHILIP HOLLANDER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB02316000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831128370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP HOLLANDER D.O.

Provider Business Mailing Address
First Line	:	401 ROUTE 73 N
Second Line	:	40 LAKE CENTER DRIVE, SUITE 201A
City	:	MARLTON
State	:	NJ
Zip	:	08053-3425
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0346

Provider Business Practice Location Address
First Line	:	103 OLD MARLTON PIKE
Second Line	:	SUITE 103
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	609-953-7105
Fax Number	:	609-953-0042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/09/2010

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